'Connectivity' as the Key to Healthy Communities

Social networks and physical infrastructure play major roles in individual health

WASHINGTON -- Keeping people connected to resources necessary to maintain good health -- not least of which is other people -- is a vital but often neglected factor in modern healthcare, policy experts and scholars said here Tuesday.

Transportation is an "underappreciated" health problem, said Dayna Bowen Matthew, JD, a nonresident senior fellow at the Brookings Center for Health Policy, at a panel discussion hosted by the Brookings Institution on Tuesday.

She noted that interstate highways aren't always a means of connecting people to each other and to resources: in cities, they create barriers as well.

A grid of superhighways can mean a person living in a city's southeast quadrant must take two buses and time off from work to reach a well-intentioned "food solution" in the northwest quadrant.

Those families across town from farmers' markets and other fresh food resources will rely on the more accessible options instead, which may be fast food.

Tuesday's discussion focused heavily on the social determinants of health -- nonmedical factors that greatly influence a population's health such as transportation, housing, access to food -- but one thing unites these influences: connectivity.

Social Networks are Key

The National Health Service in England has a "district nurse," an individual responsible for keeping watch over certain neighborhoods, explained, Stuart Butler, PhD, a senior fellow in economics for the Brookings Institution.

Growing up in England, Butler's mother ran a post office, which was a key source of "intel" for the district nurse on the community residents' well-being. If Butler's mother hadn't seen someone for a few days, the nurse would learn of this and ride her bicycle to the person's home.

Decades later and an ocean away, Matt Brown, RN, a geriatric nurse navigator at Sibley Memorial Hospital in Washington, learned quickly about the importance of follow-up phone calls to ensure smooth transitions back to the community.

During his first such call as part of a senior-focused transition project, he spoke to a patient who had just returned home after being hospitalized for pneumonia.

In the course of the phone call, the patient reluctantly admitted he had fallen and couldn't get up off the floor of his home. Brown convinced him to call 911, rather than wait for the patient's wife to come home. When the ambulance arrived, Brown spoke with the emergency medical technicians to confirm his patient was okay.

To further reduce the risk of injuries, the Sibley Innovation Hub has offered a short training course focused on transitions after certain surgeries, which they are now supplementing with animated patient education videos.

Brown also highlighted the healthcare impacts of senior villages.

In such groups a mix of volunteers and staff help seniors age safely in their homes, providing support for tasks like changing a light bulb or providing a ride to a medical appointment.

Brown also believes that leveraging social media could help increase connectivity. While the oldest seniors today may not be in tune with Facebook, he sees promise for increased connectivity and support among Baby Boomers through social media and other technologies.

Prevention over Treatment

"Fixing people who fall" costs the U.S. $30 billion a year, according to the CDC, Butler said, and the median cost of long-term care in a nursing home is about $82,000 a year.

Through creative budgeting, such as putting more dollars towards fixing a rug or ensuring a bathroom is well-designed for an older adult, the healthcare system could avoid these injuries rather than simply reacting to them, he explained.

But, he noted, "Healthcare is healthcare. Housing is housing." And shifting dollars from one to the other isn't easy.

The way incentives are designed in healthcare doesn't help. In a fee-for-service world, the more patients are admitted, the more money hospitals receive. But that paradigm is shifting.

With the 30-day readmission rule that penalizes hospitals for readmissions, and with the beginning of a movements towards value-based care -- paying to keep people healthy rather than paying for individual services -- shifting dollars towards prevention may become a reality.

For example, in response to the challenge of food insecurity that Bowen Matthew spoke of, Kavita Patel, MD, MPH, a nonresident fellow in economic studies at Brookings and a primary care internist at Johns Hopkins University, said her hospital is investigating ways mobile health clinics could double as food delivery services.

Patel was adamant that hospitals have to take more responsibility for each of these problems. Seeing only an "infinitesimal" portion of the hospital's budget directed to the community is "unacceptable," she said.

"There are many days where I go to our CEO ... and tell him he has to do better," she said.

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